Thursday, January 1, 2009

Review: Healing the mind: A history of psychiatry from antiquity to the present, Michael H. Stone, (New York, W.W. Norton, 1997)

As someone who teaches the history of psychiatry to psychiatric residents, I have long hoped to find a single textbook to spare me the chore of putting together a syllabus each year. Given the the tremendous explosion in historical studies of psychaiatry over the last thirty years, however, it has seemed unlikely that anyone would be able to produce a comprehensive and accessible history to replace Zilboorg’s History of Medical Psychology. It was, as a result, with skepticism as well as hope that I turned to Michael Stone’s Healing the Mind .

The book is well designed and will be useful to some psychiatrists. It contains many short sketches of great and not so great contributors to the field. These are clearly written and the name of each individual is printed in a wide margin alongside the sketch. If you are curious about Friedrich Scheidemantel, Henrik Sjöbring or Sacha Nacht, you will find them along, of course, with Freud and Pinel. One of the nicest features of this book is that it has numerous small pictures of the people mentioned in the text as well as classic pictures of patients. Psychiatrists lecturing on their research will find this book useful in providing material about early workers in their field as well as material for entertaining slides. Unfortunately it will not be very useful in teaching history to young psychiatrists. While the subtitle of the book “A History of Psychiatry from Antiquity to the Present” leads one to expect a broad survey, more than half of its 435 pages are devoted to the period after nineteen-sixty. As a result the first half of the book is quite sketchy while the second half reads like a series of literature reviews. More serious, however, is the fact that Stone seems unaware that there there has been and continues to be a lively debate about how to interpret psychiatry’s history. While the book has a thirty-two page bibliography, works by Michel Foucault, Roy Porter, Jan Goldstein, Elaine Showalter and John Burnham are not included. This is not to suggest that this book does not rely on secondary sources. Indeed there are so many refernces to Zilboorg, Alexander and Selesnick and Hunter and Macalpine that these are referred to simply as “Z.,” “A.&S.” and “H.& M.” There is constant tension in teaching history to young psychiatrists between their desire to translate everything historical into familiar terms and the importance of showing them that studying history can help them acheive a critical distance from which to reflect on their work. In this regard Stone’s book clearly leans toward showing how the remote or strange can be understood in terms of the familiar. Expressions such as “ an example of self-mutilation still viewed as demonic possession,” or “this view comes closer to our modern conceptions,” jump out irritatingly from too many pages. Because psychiatry has, as Michel Foucault once said, a “low epistemological profile,” it has provided a particularly good opportunity for historians to demonstrate how social, economic and political forces influence theories and practice. Stone is not interested in this angle of vision. His book does not shed much light on the growth of psychiatric institutions or their place in society. This is a book about psychiatrists and their ideas. Unfortunately it is not a very searching or critical one. His discussion of DSM III, for example, gives the reader no idea of the controversies that surrounded this fundamental change in psychiatric thinking about diagnosis. Psychiatrist will be able to use this book as a reference in certain limited circmstances, but they won’t learn much about the scholarship that has made the history of psychiatry such a rich field of study.